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General NPI Number Information
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NPI Number | 1093907008
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Entity Type | Organization
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Legal Business Name | LISMARAY LORA
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 1133 W 29 ST
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-889-3375
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Fax | 305-889-3376
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Provider Business Mailing Address
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Address Line | 1133 W 29 ST
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-889-3375
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Fax | 305-889-3376
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. IDALMIS RODRIGUEZ
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Credential |
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Telephone | 305-889-3375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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